宮頸癌和子宮肌瘤(婦產(chǎn)科)

CervicalCancer

UterinemyomaCervicalCancer2

Cervicalcancerisadiseasecausedbytheabnormalgrowthanddivisionofcellsthatmakeupthecervix,whichisthenarrow,lowerendoftheuterus(womb).CervicalCancer

(Definition)2CervicalCancer3Thisisthesecondmostcommoncanceraffectingfemales,accountingforalmost10%neoplasiaofwomen.*Themostcommonagefordetectionofcarcinomaofthecervixis50~55,whenmostotherabnormalbleedingsymptomsarealsocommonlyfound.CervicalCancer3CervicalCancer4Invasivecancerofthecervixhasbeenconsideredapreventablecancerbecauseithasalongpreinvasivestate.Cervicalcytologyscreeningprogramsareavailable,andthetreatmentofpreinvasivelesionsiseffective.CervicalCancer4CervicalCancer5RiskFactorsYoungageatfirstintercourse(＜16yrs)MultiplesexualpartnersCigarettesmokingRaceHighparityLowsocio-economicstatus5CervicalCancer6RiskFactorsViralinfection

Humanpapillomavirus(HPV)Herpessimplexvirus-2(HSV-2)HSV-2HPVHPVHPV16、186CervicalCancer7Thecervixiscomposedofthreelayersoftissue:Anouterliningknownastheserousmembrane(slipperycovering)Amiddle,muscularlayerAninnerliningknownasthemucousmembrane,whichiscomposedofthin,flat,scalycellscalledsquamouscells.Thisinnerlininghasmanytinyglandsthatsecreteaclear,lubricatingmucous.Nearlyallcervicalcancersarisefromthecellsoftheinnerliningofthecervix.

CervicalCancer

(Histology)7CervicalCancer8ExophyticorevertingvarietyEndophyticorinvertingvarietyUlcerationandcavityformationGrossPathology8CervicalCancer9Atypicalhyperplasiaordysplasia.CIN1:

onlythelowerone-thirdoftheepitheliumisreplacedbyimmatureundifferentiatedcellswithfrequentmitoses.CIN2:

Themiddlethirdoftheepitheliumisinvolved,butthereisstillsomematurationonsurface.CIN3:

Theupperthirdoftheepitheliumisinvolved.MicroscopicPathologyCIN1CIN39CervicalCancer10宮頸組織與宮頸組織病變10CervicalCancer11CarcinomainsituEarlystromalinvasionInvasivecarcinoma

Squamouscarcinoma(85%~90%)Adenocarcinoma(10%)Mixedcarcinomas(eg.adenosquamouscarcinomas)MicroscopicPathologyCarcinomainsituSquamous

carcinomaAdenocarcinomaAdenosquamouscarcinomas11CervicalCancer12DirectdisseminationLymphaticmetastasisBloodmetastasisRouteofmetastasis12CervicalCancer13Stage0:

Carcinomainsitu.Tumorispresentonlyintheepithelium(cellsliningthecervix)andhasnotinvadeddeepertissues.ClinicalStaging

(FIGOsystem2006)13CervicalCancer14StageI:Invasivecancerwithtumorstrictlyconfinedtothecervix.ClinicalStaging

(FIGOsystem2006)StageIAInthisearliestformofstageI,averysmallamountoftumorcanbeseenunderamicroscope.StageIA1Tumorhaspenetratedanarealessthan3mmdeepandlessthan7millimeterswide.StageIA2Tumorhaspenetratedanarea3to5mmdeepandlessthan7millimeterswide.14CervicalCancer15StageI:Invasivecancerwithtumorstrictlyconfinedtothecervix.ClinicalStaging

(FIGOsystem2006)StageIBThisstageincludestumorsthatcanbeseenwithoutamicroscope.Italsoincludestumorsthatcannotbeseenwithoutamicroscopebutthataremorethan7mmwideandhavepenetratedmorethan5mmofconnectivecervicaltissue.StageIB1Tumorthatisnobiggerthan4cm.StageIB2Tumorthatisbiggerthan4cm.Tumorhasspreadtoorgansandtissuesoutsidethecervixbutisstilllimitedtothepelvicarea.15CervicalCancer16StageII:Invasivecancerwithtumorextendingbeyondthecervixand/ortheuppertwo-thirdsofthevagina,butnotontothepelvicwall.ClinicalStaging

(FIGOsystem2006)StageIIATumorhasspreadbeyondthecervixtotheupperpartofthevagina.StageIIBTumorhasspreadtothetissuenexttothecervix.16CervicalCancer17StageIII:Invasivecancerwithtumorspreadingtothelowerthirdofthevaginaorontothepelvicwall;tumormaybeblockingtheflowofurinefromthekidneystothebladder.ClinicalStaging

(FIGOsystem2006)StageIIIATumorhasspreadtothelowerthirdofthevagina.StageIIIBTumorhasspreadtothepelvicwalland/orblockstheflowofurinefromthekidneystothebladder.17CervicalCancer18StageIV:Invasivecancerwithtumorspreadingtootherpartsofthebody.Thisisthemostadvancedstageofcervicalcancer.ClinicalStaging

(FIGOsystem2006)StageIVATumorhasspreadtoorganslocatednearthecervix,suchasthebladderorrectum.StageIVBTumorhasspreadtopartsofthebodyfarfromthecervix.18CervicalCancer19Earlysymptoms(1)Contactbleeding(2)

AbnormaldischargeSymptoms19CervicalCancer20Latesymptoms(1)Vaginalbleedinganddischarge(2)Painandinfection(3)Bladdersymptoms(4)Rectalsymptoms(5)Fistulaformation(6)

CachexiaSymptoms20CervicalCancer21PapsmearColposcopyDiagnosis21CervicalCancer22*Biopsy*ConebiopsyDiagnosis22CervicalCancer23Erosionofthecervixorchroniccervicitis.Tuberculosisofthecervix.Endometrialcarcinomawithmetastasistothecervix.DifferentialDiagnosis23CervicalCancer24Surgery：stageI-IIa

ovarianfunctionretainednormalvaginalfunctionretainedavoidanceofeffectofradiotherapyonbladderandbowelRadiotherapy:stageIIb、III、IVsuitableinwomenwhoareunfitforsurgery

Chemotherapy：LatestageandmetastasisPalliativecareTreatment24CervicalCancer25Prognosis

(Five-yearsurvivalrate)IIIaIIbRadiation93.4%82.7%26.6%Surgery95%74.31%66.67%25CervicalCancer26Every3to4monthsduringthefirst2yearsandevery6monthsthereafter.ChestX-rayevery12months.SerumCA125measurement.Follow-upafterTreatment26CervicalCancer27ThebestwaytodetectearlycervicalcancerandprecancerousconditionsofthecervixistohaveagynecologicexaminationandPaptest.TheAmericanCancerSociety(ACS)recommendsthatawomanhaveherfirstannualPaptestwhenshebecomessexuallyactiveorreachestheageof18.Prevention27CervicalCancer28cervicalcancerusuallyprogressesslowly,somephysiciansfeelthatawomandoesn'tneedtohaveaPaptesteveryyearifshe:Is65yearsofageorolderHashadnormalPaptestsforthreeyearsinarowPrevention28CervicalCancer29SourcesofInformation1.AmericanCancerSociety(ACS):2.NationalCancerInstitute(NCI),CancerInformationService:3.AmericanMedicalWomen'sAssociation:/cervical.html4.CancerNewsontheNet:

/5.NationalCervicalCancerCoalition:

6.Women'sCancerNetwork:29女性生殖系統(tǒng)最常見的良性腫瘤平滑肌及結(jié)締組織組成常見于30－50歲女性，20歲以下少見30歲以上女性20％以上有肌瘤子宮肌瘤（uterinemyoma)30子宮肌瘤相關(guān)因素雌激素有關(guān)好發(fā)于生育年齡女性，青春期少見，絕經(jīng)后萎縮肌瘤組織中雌酮轉(zhuǎn)化率低肌瘤組織中ER明顯高于周邊組織孕激素因素孕激素可以促進(jìn)肌瘤細(xì)胞有絲分裂刺激肌瘤生長31細(xì)胞遺傳學(xué)異常

25％－50％肌瘤存在細(xì)胞遺傳學(xué)異常

12與17號染色體長臂部分片段互換

12號染色體部分重排

7號染色體部分缺失32

分類按肌瘤生長部位宮體肌瘤（90％）宮頸肌瘤（10％）按肌瘤與子宮壁的關(guān)系肌壁間肌瘤（60％－70％）漿膜下肌瘤（20％）粘膜下肌瘤（10％－15％）33病理巨檢